Breastfeeding 101

Hi future mama!

**This might seem like a lot of information, but I tried to include all of the helpful hints I have found, so don’t freak out! It doesn’t take too long to read and covers a LOT of information. Remember, this is just based on my own experience and research, and is not a substitute for medical advice.**
 
Here is some of my best advice for breastfeeding:
The first 3 weeks are the hardest. After 6 weeks it gets easier. By 3 months you will feel sorry for people that have to mix formula!
*Don’t give up, give it a good try, at least 6 weeks.* It gets easier, I promise! Anything worth doing is hard. It gets so much easier after they can hold their head up more. Feed BEFORE he is crying (Look for rooting, smacking/licking his lips, turning his head as if seeking milk, putting hand to his mouth, etc). *Feed on demand*
 
First day: Let baby find his way to begin nursing; it is amazing. They need to get a deep, asymmetrical latch. (Lips are flared out, angle of the lips is 140 degrees or more, latched on to the whole areola, not just the nipple tip, chin touching the breast). The yellow stuff is colostrum, it is highly nutritious and is very small quantities because that is all they need. Your milk will “come in” in a few days and will be whiter, you will feel more engorged and may get clogs- keep nursing on! Baby is expected to lose a percentage of their birth weight in the first week, this is normal. It is often recommended to wake baby up every 2.5-3 hours around the clock to nurse if baby doesn’t wake up on his own, until they regain their birth weight. Then you can let them sleep longer if they are healthy. (No more than 4 hours without feeding in the day time.)
 
Growth spurts: They go through many growth spurts, including at 10 days, 6 weeks, 2 months, 3 months, 4 months, 6 months, etc. They might sleep less, nurse more, and be more fussy. 6 weeks and 4 months are especially big. They normally are working through a developmental stage and will then start sitting up, crawling, etc.
Baby will want to eat all the time at first, especially the first few weeks. Just settle down on the couch or bed with some good books and movies and let him nurse whenever he wants. Always nurse on demand! He might not want to eat, he might just want to suck for comfort. But everytime he nurses, he is setting up your supply for the future! After about 12 weeks your milk should be regulated, and you might not feel like your breasts are full anymore, but this is normal and does not mean you are not making enough milk! Just because he wants to nurse all the time, acts hungry 10 minutes later, and pulls/tugs/cries at the breast, does not mean you are not making enough milk, it is normal! Their stomachs are smaller than a marble the first few weeksso they fill up and get hungry again very quickly. But as he grows, he will be able to go longer times in between feedings.
 
He will start going 2.5-3 hours between feedings in the daytime, cluster feed in the evening (lots of nursing), and at nights it could be anything. “Sleeping through the night” is technically 5-6 hours, but EVERY baby is different, and they go through cycles. He might sleep 6 hours, then eat every 3, he might do an 8 hour stretch for a couple days, then go back to every 2 hours.
As long as he is having many wet diapers and gaining weight, you are making enough milk!! So avoid supplementation with formula. If you give a bottle of formula, your body doesn’t know and thinks he doesn’t need so much milk, so it will start making less, then you have to supplement more, and that is how your supply will end up drying up. So keep nursing, mama!

Try to avoid giving a pacifier or bottle for the first couple weeks, but if you have to, that is okay. “Nipple confusion” is actually “flow of milk preference.” In other words, it is easier for them to get milk out of a bottle so they prefer that over working at the breast. Once you start bottle feeding, stay at a low-flow nipple size.
Get a lactation consultant to see you BEFORE you leave the hospital! They will show you how manually pump, hand express, positioning, and proper latch, which is SO important.
Pumping: A few weeks before going back to work, start pumping after a feeding each day, slowly increasing until you have a freezer stash for you first day back at work  After that first day, he can get fresh from the fridge because the milk in the fridge is good for 6-8 days. (Just smell it first. Soapy smell is okay, sour is not). The best time to pump is early morning between 1-4am because you make a lot of milk then! Keep in mind, pumping is NOT a good indicator of how much milk you are making. Your Little One is much more efficient at emptying the breast, pumps are just machines. The first couple weeks you only make an ounce or two at a time, this is normal! Your body will get used to the pump and should start increasing. If you have problems, let me know. You might need bigger/smaller flange sizes, or new membranes/diapghrams on your pump. Make sure you get a good quality double electric pump. Most insurances will pay for a pump for free! Call them up and ask. I got a $300 pump bundle for free.
 
Pour the milk into freezer bags (Laninsoh brand, or Target brand are good), and lay them FLAT to freeze for more space in your fridge. You can let them thaw in the fridge, or warm them under running water (never microwave breast milk, and never shake it to mix the fat, just swirl the bottle. The milk will separate in the fridge or at room temp and that is fine. The fat is good) Use the oldest bags first.
Every time you give baby a bottle of milk, you need to pump to replace your stash. Otherwise, you will keep using your stash up, and your body will be making less milk.
 
How to get your supply up: Pump after he eats. Pump the side that he is not eating. Pump between 1-4AM. If you have trouble with let-down (when your milk starts flowing out), try a warm shower. Pump for 5 minutes after the last drop of milk. (You won’t have to do this forever, just until your supply is good.) Nurse frequently. Power pump: pump for ten minutes and rest for ten minutes, and repeat for an hour. This mimicks cluster feeding. Drink lots of water, gatorade. Eat oatmeal, almonds, almond milk. There are also lactation cookies and teas. There are other things you can do if you are having a lot of issues, get help before it is too late.
Nurse one side “the dinner side”, then offer the other side “the dessert side.” Even if he doesn’t eat much from that side, it stimulates your body to make milk for next time. Burp between sides.
As a side note, if for some reason you have to exclusively pump, you have to pump every 3 hours around the clock to keep your supply up, even if baby is sleeping in the night, because the pump is not as efficient as baby. Then after 12 weeks you can start dropping a pump and wait a couple weeks to make sure you will not lose your supply. Otherwise, add the pump back in. Join the Exclusively Pumping group on facebook.
 
When to pump at work (for 12 hours shifts): I highly recommend pumping in the car. You can order a car adapter for your specific pump for $10 on amazon. You will also need a pumping bra, I recommend www.simplewishes.com, the DLITE is inexpensive and works for all models. With a bra, you can then have your hands free to massage and compress, which will get the milk out faster. So, if you pump on the way to work and back home, you will need to pump three more times at work. Within a week or two, you should be able to get to the back exam room, set it up, pump, and back to the front in 15 minutes. So two 15 minute breaks, and on your lunch break. Another way to do it is pump every 3 hours at work, or pump when baby eats. After 12 weeks when your supply is set up, you can drop out a pump by spreading out the other pump times. (I pump at 1030 and 3, plus the two when driving). If you notice a big drop in your supply, you can always add it back in. Remember, it is your legal right to pump as often as you need at work, for the first year, in a private place other than the bathroom. So if you need to pump more often than the above, do so! Your baby is priority!

Feeding bottles: Baby needs about an ounce an hour via bottle, so about 24-25 ounces a day. They should not get more than 3-4 ounces at a time. You can offer another ounce after an hour if needed. Babies can overeat on the bottle, because they also suck for comfort on the breast, but end up eating when they try to do that with the bottle. So they normally will eat about 3-3.5 ounces every 3 hours, or 2 ounces every 2 hours, something like that. If he acts hungry, try a pacifier or try fresh air/bath/rocking/walking/etc. Cry does not always = hunger. (They eat WAY less than this the first days and weeks.) Burp often, every ounce or two. Change arms when feeding. Take the bottle out of his mouth periodically so he slows down his feeding. Nurse when you are home (nights, days off) as much as he wants. Do not feed more than 4 ounces at a time or you will stretch their stomaches, then they will cry for more food because it soothes them, but it will hurt them more. Formua Fed babies need greater and greater amounts, but our milk changes with their baby, so the Quality of the milk changes, not the Quantity.

Benefits of nursing: I know you know the obvious health benefits (less allergies, sicknesses, infections, decreased risk of breast cancer for you, etc), but here are some other benefits:

1) Poop does not smell! Seriously, this alone is worth all the trouble. They also might poop less because milk is so easily digested.
2) My husband is so jealous: when baby is fussy, he has to rock, walk, take for fresh air, sing, read a story, bathe, swaddle, white noise, etc. 9 times out of 10, all I have to do is pop him on the boob, no matter why he is fussy. It is fantastic!
3) You can eat more food and lose weight faster!
4) Cuddle times with Little One!
5) You don’t have to go downstairs, clean bottles, mix formula, warm up bottles, etc multiple times in the night. Boob and done.
6) Formula babies are much more gassy and fussy.
7) Formula is 87% oil and sugar.

How long: It is recommended by every nursing organization to exclusively give breastmilk for the first 6 months, and continue nursing at least for a year. Then you can introduce solids a little bit, but always nurse before solids and “Food before one is just for fun.” You can research the nonutritive values of cereal, and Baby Led Weaning (feeding solids instead of purees) when it gets closer to that time.
Pain: it will hurt the first few weeks. You are both still learning what to do. Lanolin is often recommended, but so is natural organic nipple butter or creams, soothies, warmed up rice-socks, and many other things. The best is just to express some milk on the nipple after each feeding and let it air dry. They will eventually toughen up. If the pain is extreme, look into tongue/lip ties (mine had this, see Tongue Tied Babies Support Group on facebook) or research mastitis/thrush symptoms and treatments. If you are sick, keep nursing, baby will get your antibodies.

Other resources: www.kellymom.com is the best resource for everything breastfeeding related.
Nurse on, mama! You are doing a great job!
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